What is Zaroxolyn used for. How does metolazone work. What are the common side effects of Zaroxolyn. Who should not take metolazone. How should this medication be taken. What are the potential drug interactions with Zaroxolyn.

Understanding Zaroxolyn: A Comprehensive Guide to Metolazone

Zaroxolyn, also known by its generic name metolazone, is a medication that belongs to the class of drugs called diuretics. This powerful medication is widely used in the treatment of various medical conditions, primarily hypertension and edema. But what exactly is Zaroxolyn, and how does it work in the body?

What is Zaroxolyn?

Zaroxolyn is a brand name for metolazone, a thiazide-like diuretic that helps the body eliminate excess water and salt. It’s available as a pink, slightly biconvex tablet, debossed with its numeric strength on one side and “ZAROXOLYN” on the other. Each tablet contains 2.5 mg of metolazone, along with inactive ingredients such as microcrystalline cellulose, D&C Red No. 33 Aluminum Lake, and magnesium stearate.

How Does Metolazone Work?

Metolazone works by increasing the amount of water and salt expelled from the body as urine. This action helps reduce blood volume, which in turn lowers blood pressure. Additionally, it aids in removing excess fluid that accumulates in conditions such as congestive heart failure and certain kidney diseases.

Medical Uses of Zaroxolyn: Treating Hypertension and Edema

Zaroxolyn is primarily prescribed for two main medical conditions: hypertension (high blood pressure) and edema (fluid retention). Let’s explore these uses in more detail:

Zaroxolyn for Hypertension

For the treatment of high blood pressure, Zaroxolyn is typically prescribed in doses ranging from 2.5 mg to 5 mg once daily. It’s important to note that it may take 3 to 6 weeks for metolazone to start effectively reducing blood pressure.

Zaroxolyn for Edema

In cases of edema, such as that occurring in congestive heart failure or certain kidney diseases, the usual dose of Zaroxolyn ranges from 5 to 20 mg once daily. Patients often notice a reduction in edema within 3 to 4 days of starting treatment.

Proper Usage and Dosage Guidelines for Zaroxolyn

The correct usage of Zaroxolyn is crucial for its effectiveness and safety. Here are some important guidelines to follow:

• Take Zaroxolyn exactly as prescribed by your doctor.
• The typical dose ranges from 2.5 mg to 20 mg daily, depending on the condition being treated and individual patient factors.
• If you miss a dose, take it as soon as you remember. However, if it’s almost time for your next dose, skip the missed dose and continue with your regular schedule.
• Never take a double dose to make up for a missed one.
• Store Zaroxolyn at room temperature, protected from light and moisture, and out of reach of children.

Potential Side Effects of Metolazone: What to Watch For

Like all medications, Zaroxolyn can cause side effects. While not everyone experiences these, it’s important to be aware of potential adverse reactions:

Common Side Effects

• Decreased sexual ability
• Diarrhea
• Dizziness or lightheadedness, especially when getting up from a lying or sitting position
• Fatigue
• Increased sensitivity of skin to sunlight
• Loss of appetite
• Upset stomach

Serious Side Effects

While less common, the following side effects require immediate medical attention:

• Flu-like symptoms (e.g., fever, chills, sore throat, cough, achiness)
• Joint pain
• Skin rash or hives
• Signs of excessive potassium loss (e.g., dry mouth, increased thirst, irregular heartbeat, mood changes)

Contraindications: Who Should Not Take Zaroxolyn?

While Zaroxolyn is an effective medication for many, it’s not suitable for everyone. The following individuals should not take this medication:

• Those allergic to metolazone or any ingredients in the medication
• Individuals unable to urinate
• People in hepatic coma or pre-coma

It’s crucial to inform your healthcare provider about all your medical conditions and medications before starting Zaroxolyn to ensure its safety and appropriateness for you.

Drug Interactions: Understanding Zaroxolyn’s Impact on Other Medications

Zaroxolyn can interact with various other medications, potentially altering their effectiveness or increasing the risk of side effects. Some important drug interactions to be aware of include:

Interactions with Other Blood Pressure Medications

Zaroxolyn may enhance the effects of other blood pressure medications, potentially leading to excessive blood pressure reduction. This interaction requires careful monitoring and dose adjustment.

Interactions with Lithium

Metolazone can increase lithium levels in the blood, potentially leading to lithium toxicity. Close monitoring of lithium levels is essential when these medications are used together.

Interactions with NSAIDs

Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen may reduce the effectiveness of Zaroxolyn. They can also increase the risk of kidney problems when used with metolazone.

Interactions with Diabetes Medications

Zaroxolyn may affect blood sugar levels, potentially interfering with the action of diabetes medications. Blood glucose monitoring may need to be more frequent when starting or adjusting Zaroxolyn dosage.

Special Precautions and Considerations When Taking Zaroxolyn

While Zaroxolyn is generally safe when used as directed, certain precautions should be taken to ensure its safe and effective use:

Monitoring Electrolyte Levels

Zaroxolyn can affect the balance of electrolytes in your body, particularly potassium. Regular blood tests to monitor electrolyte levels may be necessary during treatment.

Sun Sensitivity

Metolazone can increase skin sensitivity to sunlight. It’s advisable to use sunscreen and protective clothing when exposed to the sun while taking this medication.

Pregnancy and Breastfeeding

The safety of Zaroxolyn during pregnancy and breastfeeding has not been fully established. If you’re pregnant, planning to become pregnant, or breastfeeding, discuss the potential risks and benefits with your healthcare provider.

Elderly Patients

Older adults may be more sensitive to the effects of Zaroxolyn, particularly its impact on blood pressure and electrolyte balance. Dose adjustments may be necessary for this population.

Managing Side Effects: Tips for Zaroxolyn Users

While side effects can be concerning, there are strategies to manage them effectively:

Dealing with Dizziness

To minimize dizziness, especially when standing up:

• Rise slowly from a sitting or lying position
• Avoid alcohol, which can worsen this effect
• Stay hydrated, unless otherwise instructed by your doctor

Managing Increased Sun Sensitivity

To protect yourself from increased sun sensitivity:

• Use a broad-spectrum sunscreen with high SPF
• Wear protective clothing when outdoors
• Avoid prolonged sun exposure, especially during peak hours

Coping with Gastrointestinal Side Effects

If you experience upset stomach or loss of appetite:

• Take Zaroxolyn with food
• Eat smaller, more frequent meals
• Avoid spicy or fatty foods that may exacerbate symptoms

Long-Term Use of Zaroxolyn: What You Need to Know

For many patients, Zaroxolyn may be prescribed for long-term use. Here are some important considerations for those on extended therapy:

Regular Monitoring

Long-term use of Zaroxolyn requires regular medical check-ups. Your healthcare provider will likely monitor:

• Blood pressure
• Kidney function
• Electrolyte levels
• Blood sugar levels, especially in diabetic patients

Potential for Tolerance

Some patients may develop tolerance to the blood pressure-lowering effects of Zaroxolyn over time. If this occurs, your doctor may adjust your dosage or add another medication to your regimen.

Lifestyle Modifications

To enhance the effectiveness of Zaroxolyn and promote overall health, consider incorporating these lifestyle changes:

• Maintain a healthy diet low in sodium
• Engage in regular physical activity
• Limit alcohol consumption
• Quit smoking if you’re a smoker

Zaroxolyn vs. Other Diuretics: Understanding the Differences

While Zaroxolyn belongs to the diuretic class of medications, it has some unique characteristics that set it apart from other diuretics:

Comparison with Thiazide Diuretics

Zaroxolyn is often classified as a thiazide-like diuretic, but it has some key differences from traditional thiazides:

• Longer duration of action
• More potent diuretic effect
• May be effective in patients with reduced kidney function

Comparison with Loop Diuretics

Loop diuretics like furosemide (Lasix) are another class of diuretics. Compared to loop diuretics, Zaroxolyn:

• Has a more gradual onset of action
• Provides longer-lasting effects
• May be less likely to cause severe electrolyte imbalances

Combination Therapy

In some cases, Zaroxolyn may be prescribed in combination with other diuretics or blood pressure medications for enhanced effectiveness. This approach requires careful monitoring by a healthcare professional.

Frequently Asked Questions About Zaroxolyn

Here are answers to some common questions about Zaroxolyn:

Can I drink alcohol while taking Zaroxolyn?

It’s generally advisable to avoid alcohol while taking Zaroxolyn. Alcohol can increase the risk of dehydration and may enhance the blood pressure-lowering effects of the medication, potentially leading to dizziness or fainting.

Will Zaroxolyn affect my ability to drive?

Zaroxolyn can cause dizziness, especially when you first start taking it. It’s recommended to avoid driving or operating machinery until you know how the medication affects you.

Can I take over-the-counter pain relievers with Zaroxolyn?

Some over-the-counter pain relievers, particularly NSAIDs like ibuprofen, can interact with Zaroxolyn. Always consult your healthcare provider before taking any additional medications.

How long will I need to take Zaroxolyn?

The duration of Zaroxolyn treatment varies depending on your specific condition and response to the medication. Many patients with chronic conditions like hypertension may need to take it long-term. Always follow your doctor’s instructions regarding the duration of treatment.

Improving Quality of Life with Zaroxolyn: Patient Experiences

While individual experiences with Zaroxolyn can vary, many patients report significant improvements in their quality of life after starting this medication. Here are some common positive outcomes:

Better Blood Pressure Control

Many patients with hypertension find that Zaroxolyn helps them achieve and maintain healthier blood pressure levels, reducing their risk of cardiovascular complications.

Reduced Edema

For those suffering from fluid retention, Zaroxolyn can provide relief from swelling and discomfort, particularly in the legs and feet.

Improved Heart Function

In patients with congestive heart failure, the reduction in fluid overload can lead to improved heart function and reduced symptoms like shortness of breath.

Enhanced Daily Activities

With better management of hypertension and edema, many patients report increased energy levels and ability to engage in daily activities.

It’s important to note that while these positive experiences are common, each patient’s journey with Zaroxolyn is unique. Regular communication with your healthcare provider is key to ensuring the best possible outcomes from your treatment.

Zaroxolyn – Uses, Side Effects, Interactions

How does this medication work? What will it do for me?

Metolazone belongs to the class of medications called diuretics. It is used to treat blood pressure and to remove excessive water (edema) that occurs in such conditions as congestive heart failure and some forms of kidney disease.

It usually takes 3 to 4 days for metolazone to start reducing edema, and 3 to 6 weeks to start reducing blood pressure.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor.  Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

Each pink, slightly biconvex tablet, debossed with its numeric strength on one side and “ZAROXOLYN” on the other, contains metolazone 2.5 mg. Nonmedicinal ingredients: microcrystalline cellulose, D&C Red No. 33 Aluminum Lake, and magnesium stearate. This medication does not contain alcohol, gluten, lactose, paraben, sucrose, or tartrazine.

How should I use this medication?

The recommended dose of metolazone ranges from 2.5 mg to 20 mg daily depending on the condition being treated and the circumstances of the person taking the medication. For treatment of high blood pressure, the usual dose is 2. 5 mg to 5 mg once daily. For treatment of edema, the usual dose ranges from 5 to 20 mg once daily.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e. g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not take this medication if you:

• are allergic to metolazone or any ingredients of this medication
• are unable to urinate

Do not give this medication to people who are in hepatic coma or pre-coma.

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• decreased sexual ability
• diarrhea
• dizziness or lightheadedness when getting up from a lying or sitting position
• fatigue
• increased sensitivity of skin to sunlight
• loss of appetite
• upset stomach

Although most of the side effects listed below don’t happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• flu-like symptoms (e.g., fever or chills, sore throat, cough, achiness)
• joint pain
• skin rash or hives
• signs and symptoms of too much potassium loss:
• dryness of mouth
• increased thirst
• irregular heartbeat
• mood or mental changes
• muscle cramps or pain
• nausea or vomiting
• unusual tiredness or weakness
• weak pulse
• signs and symptoms of too much sodium loss:
• confusion
• convulsions
• decreased mental activity
• irritability
• muscle cramps
• unusual tiredness or weakness

• signs of kidney problems (e. g., increased urination at night, decreased urine production, blood in the urine, change of urine colour)
• signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)
• symptoms of high blood sugar (e.g., frequent urination, increased thirst, excessive eating, unexplained weight loss, poor wound healing, infections, fruity breath odour)

Stop taking the medication and seek immediate medical attention if any of the following occur:

• chest pain
• signs of a serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)
• signs of pancreatitis (e.g., abdominal pain on the upper left side, back pain, nausea, fever, chills, rapid heartbeat, swollen abdomen)
• signs of a severe skin reaction such as blistering, peeling, a rash covering a large area of the body, a rash that spreads quickly, or a rash combined with fever or discomfort

Some people may experience side effects other than those listed.  Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin taking a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should take this medication.

Diabetes: If you have diabetes, your doctor should closely monitor your condition while you are taking metolazone, as it may affect blood sugar control (by increasing blood sugar levels).

Electrolytes: Metolazone may cause imbalances of electrolytes in the blood such as potassium, sodium, and magnesium. The signs of electrolyte imbalance include:

• drowsiness
• dry mouth
• lethargy
• low blood pressure
• muscle fatigue
• muscle pains or cramps
• racing heart rate
• reduced urine output
• restlessness
• stomach disturbances such as nausea and vomiting
• thirst
• weakness

If you have these symptoms, contact your doctor as soon as possible.

Gout: High blood uric acid levels may be brought on by metolazone. This may result in a gout attack for people with a history of gout. If you have a history of gout, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Kidney and liver function: If you have reduced kidney or liver function, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Low blood pressure: Some people taking metolazone experience sudden blood pressure drops when getting up from a sitting or lying position. These blood pressure drops could lead to dizziness, lightheadedness, and falls. If you experience this problem, try getting up more slowly. If it persists or if you faint, contact your doctor.

Systemic lupus erythematosus: This medication can worsen or activate the symptoms of lupus. If you experience swollen and painful joints, fever, fatigue, or rash on the nose and cheeks while taking this medication, contact your doctor.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: This medication passes into breast milk. If you are a breast-feeding mother and are taking metolazone, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children.

What other drugs could interact with this medication?

There may be an interaction between metolazone and any of the following:

• aclidinium
• alcohol
• aldesleukin
• allopurinol
• alpha blockers (e. g., alfuzosin, doxazosin, tamsulosin)
• amiodarone
• amphetamines (e.g., dextroamphetamine, lisdexamfetamine)
• angiotensin converting enzyme inhibitors (ACEIs; captopril, ramipril)
• antihistamines (e.g., cetirizine, doxylamine, diphenhydramine, hydroxyzine, loratadine)
• antipsychotics (e.g., chlorpromazine, clozapine, haloperidol, olanzapine, quetiapine, risperidone)
• atropine
• barbiturates (e.g., butalbital, phenobarbital)
• belladonna
• benztropine
• beta 2 agonists (bronchodilators; e.g., salbutamol, formoterol, indacaterol)
• brimonidine
• calcium supplements (e.g., calcium carbonate, calcium citrate)
• carbamazepine
• cholestyramine
• colestipol
• corticosteroids (e.g., beclomethasone, dexamethasone, fluticasone, hydrocortisone, prednisone)
• cyclobenzaprine
• cyclophosphamide
• darifenacin
• diabetes medications (e. g., chlorpropamide, insulin, glyburide, metformin, rosiglitazone)
• digoxin
• disopyramide
• other diuretics (water pills; e.g., furosemide, hydrochlorothiazide, triamterene)
• dofetilide
• duloxetine
• flavoxate
• glycopyrrolate
• ipratropium
• ivabradine
• ketotifen
• levodopa
• lithium
• medications that lower blood pressure methadone
• methylphenidate
• multivitamin/mineral supplements
• narcotic pain relievers (e.g., codeine, fentanyl, morphine, oxycodone)
• nitrates (e.g., nitroglycerin, isosorbide dinitrate, isosorbide mononitrate)
• nonsteroidal anti-inflammatory medications (NSAIDs; e.g., ibuprofen, naproxen)
• obinutuzumab
• orphenadrine
• oxcarbazepine
• oxybutynin
• phosphodiesterase 5 inhibitors (e.g., sildenafil, tadalafil, vardenafil)
• pentixifylline
• porfimer
• quinine
• quinidine
• scopolamine
• selective serotonin reuptake inhibitors (SSRIs; e. g., citalopram, fluoxetine, paroxetine, sertraline)
• sodium phosphates
• solifenacin
• tiotropium
• tizanidine
• tolcapone
• tolterodine
• topiramate
• tranylcypromine
• tricyclic antidepressants (e.g., amitriptyline, clomipramine, desipramine, trimipramine)
• umeclidinium
• verteporfin
• vitamin D analogues (e.g., alfacalcidol, calcitriol, cholecalciferol)
• yohimbine

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

All material copyright MediResource Inc. 1996 – 2021. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/drug/getdrug/Zaroxolyn

Metolazone tablets

What is this medicine?

METOLAZONE (me TOLE a zone) is a diuretic. It increases the amount of urine passed, which causes the body to lose salt and water. This medicine is used to treat high blood pressure. It is also reduces the swelling and water retention caused by heart or kidney disease.

This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

COMMON BRAND NAME(S): Mykrox, Zaroxolyn

What should I tell my health care provider before I take this medicine?

They need to know if you have any of these conditions:

• diabetes
• gout
• immune system problems, like lupus
• kidney disease
• liver disease
• pancreatitis
• small amount of urine or difficulty passing urine
• an unusual or allergic reaction to metolazone, sulfa drugs, other medicines, foods, dyes, or preservatives
• pregnant or trying to get pregnant
• breast-feeding

How should I use this medicine?

Take this medicine by mouth with a glass of water. Follow the directions on the prescription label. Remember that you will need to pass urine frequently after taking this medicine. Do not take your doses at a time of day that will cause you problems. Do not take at bedtime. Take your medicine at regular intervals. Do not take your medicine more often than directed. Do not stop taking except on your doctor’s advice.

Talk to your pediatrician regarding the use of this medicine in children. Special care may be needed.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.

NOTE: This medicine is only for you. Do not share this medicine with others.

What if I miss a dose?

If you miss a dose, take it as soon as you can. If it is almost time for your next dose, take only that dose. Do not take double or extra doses.

What may interact with this medicine?

• alcohol
• antiinflammatory drugs for pain or swelling
• barbiturates for sleep or seizure control
• digoxin
• dofetilide
• lithium
• medicines for blood sugar
• medicines for high blood pressure
• medicines that relax muscles for surgery
• methenamine
• other diuretics
• some medicines for pain
• steroid hormones like cortisone, hydrocortisone, and prednisone
• warfarin

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I watch for while using this medicine?

Visit your doctor or health care professional for regular checks on your progress. Check your blood pressure as directed. Ask your doctor or health care professional what your blood pressure should be and when you should contact him or her.

You may need to be on a special diet while taking this medicine. Ask your doctor.

Check with your doctor or health care professional if you get an attack of severe diarrhea, nausea and vomiting, or if you sweat a lot. The loss of too much body fluid can make it dangerous for you to take this medicine.

You may get drowsy or dizzy. Do not drive, use machinery, or do anything that needs mental alertness until you know how this medicine affects you. Do not stand or sit up quickly, especially if you are an older patient. This reduces the risk of dizzy or fainting spells. Alcohol may interfere with the effect of this medicine. Avoid alcoholic drinks.

This medicine may affect your blood sugar level. If you have diabetes, check with your doctor or health care professional before changing the dose of your diabetic medicine.

This medicine can make you more sensitive to the sun. Keep out of the sun. If you cannot avoid being in the sun, wear protective clothing and use sunscreen. Do not use sun lamps or tanning beds/booths.

What side effects may I notice from receiving this medicine?

Side effects that you should report to your doctor or health care professional as soon as possible:

• allergic reactions such as skin rash or itching, hives, swelling of the lips, mouth, tongue, or throat
• fast or irregular heartbeat, chest pain
• feeling faint
• fever, chills
• gout pain
• hot red lump on leg
• muscle pain, cramps
• nausea, vomiting
• numbness or tingling in hands, feet
• pain or difficulty when passing urine
• redness, blistering, peeling or loosening of the skin, including inside the mouth
• unusual bleeding or bruising
• unusually weak or tired
• yellowing of the eyes, skin

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):

• abdominal pain
• blurred vision
• constipation or diarrhea
• dry mouth
• headache

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Where should I keep my medicine?

Keep out of the reach of children.

Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F). Protect from light. Keep container tightly closed. Throw away any unused medicine after the expiration date.

NOTE: This sheet is a summary. It may not cover all possible information. If you have questions about this medicine, talk to your doctor, pharmacist, or health care provider.

Metolazone FDA Warnings & Precautions | Healthgrades

rapid onset hyponatremia & / or hypokalemia

Rarely, the rapid onset of severe hyponatremia and/or hypokalemia has been reported following initial doses of thiazide and non-thiazide diuretics. When symptoms consistent with severe electrolyte imbalance appear rapidly, drug should be discontinued and supportive measures should be initiated immediately. Parenteral electrolytes may be required. Appropriateness of therapy with this class of drugs should be carefully reevaluated.

Hypokalemia may occur with consequent weakness, cramps, and cardiac dysrhythmias. Serum potassium should be determined at regular and appropriate intervals, and dose reduction, potassium supplementation or addition of a potassium-sparing diuretic instituted whenever indicated. Hypokalemia is a particular hazard in patients who are digitalized or who have or have had a ventricular arrhythmia; dangerous or fatal arrhythmias may be precipitated. Hypokalemia is dose related.

lithium

In general, diuretics should not be given concomitantly with lithium because they reduce its renal clearance and add a high risk of lithium toxicity. Read prescribing information for lithium preparations before use of such concomitant therapy.

furosemide

Unusually large or prolonged losses of fluids and electrolytes may result when metolazone tablets, USP, are administered concomitantly to patients receiving furosemide (see PRECAUTIONS, Drug Interactions).

other antihypertensive drugs

When metolazone tablets, USP, are used with other antihypertensive drugs, particular care must be taken to avoid excessive reduction of blood pressure, especially during initial therapy.

Cross-allergy may occur when metolazone tablets, USP, are given to patients known to be allergic to sulfonamide-derived drugs, thiazides, or quinethazone.

Sensitivity reactions (e.g., angioedema, bronchospasm) may occur with or without a history of allergy or bronchial asthma and may occur with the first dose of metolazone tablets, USP.

DO NOT INTERCHANGE UPSTATE’S METOLAZONE TABLETS, USP, ZAROXOLYN TABLETS, AND OTHER FORMULATIONS OF METOLAZONE THAT SHARE THEIR SLOW AND INCOMPLETE BIOAVAILABILITY AND ARE NOT THERAPEUTICALLY EQUIVALENT AT THE SAME DOSES TO MYKROX TABLETS, A MORE RAPIDLY AVAILABLE AND COMPLETELY BIOAVAILABLE METOLAZONE PRODUCT. FORMULATIONS BIOEQUIVALENT TO ZAROXOLYN AND FORMULATIONS BIOEQUIVALENT TO MYKROX SHOULD NOT BE INTERCHANGED FOR ONE ANOTHER.

fluid & electrolytes

All patients receiving therapy with metolazone tablets, USP, should have serum electrolyte measurements done at appropriate intervals and be observed for clinical signs of fluid and/or electrolyte imbalance: namely, hyponatremia, hypochloremic alkalosis, and hypokalemia. In patients with severe edema accompanying cardiac failure or renal disease, a low-salt syndrome may be produced, especially with hot weather and a low-salt diet. Serum and urine electrolyte determinations are particularly important when the patient has protracted vomiting, severe diarrhea, or is receiving parenteral fluids. Warning signs of imbalance are: dryness of mouth, thirst, weakness, lethargy, drowsiness, restlessness, muscle pains or cramps, muscle fatigue, hypotension, oliguria, tachycardia, and gastrointestinal disturbances such as nausea and vomiting. Hyponatremia may occur at any time during long term therapy and, on rare occasions, may be life threatening.

The risk of hypokalemia is increased when larger doses are used, when diuresis is rapid, when severe liver disease is present, when corticosteroids are given concomitantly, when oral intake is inadequate or when excess potassium is being lost extrarenally, such as with vomiting or diarrhea.

Thiazide-like diuretics have been shown to increase the urinary excretion of magnesium; this may result in hypomagnesemia.

glucose tolerance

Metolazone may raise blood glucose concentrations possibly causing hyperglycemia and glycosuria in patients with diabetes or latent diabetes.

hyperuricemia

Metolazone tablets, USP, regularly cause an increase in serum uric acid and can occasionally precipitate gouty attacks even in patients without a prior history of them.

azotemia

Azotemia, presumably prerenal azotemia, may be precipitated during the administration of metolazone tablets, USP. If azotemia and oliguria worsen during treatment of patients with severe renal disease, metolazone tablets, USP, should be discontinued.

renal impairment

Use caution when administering metolazone tablets, USP, to patients with severely impaired renal function. As most of the drug is excreted by the renal route, accumulation may occur.

orthostatic hypotension

Orthostatic hypotension may occur; this may be potentiated by alcohol, barbiturates, narcotics, or concurrent therapy with other antihypertensive drugs.

hypercalcemia

Hypercalcemia may infrequently occur with metolazone, especially in patients taking high doses of vitamin D or with high bone turnover states, and may signify hidden hyperparathyroidism. Metolazone should be discontinued before tests for parathyroid function are performed.

systemic lupus erythematosus

Thiazide diuretics have exacerbated or activated systemic lupus erythematosus and this possibility should be considered with metolazone tablets, USP.

Patients should be informed of possible adverse effects, advised to take the medication as directed, and promptly report any possible adverse reactions to the treating physician.

diuretics

Furosemide and probably other loop diuretics given concomitantly with metolazone can cause unusually large or prolonged losses of fluid and electrolytes (see WARNINGS).

other antihypertensives

When metolazone tablets, USP, are used with other antihypertensive drugs, care must be taken, especially during initial therapy. Dosage adjustments of other antihypertensives may be necessary.

alcohol, barbiturates, & narcotics

The hypotensive effects of these drugs may be potentiated by the volume contraction that may be associated with metolazone therapy.

digitalis glycosides

Diuretic-induced hypokalemia can increase the sensitivity of the myocardium to digitalis. Serious arrhythmias can result.

corticosteroids or acth

May increase the risk of hypokalemia and increase salt and water retention.

lithium

Serum lithium levels may increase (see WARNINGS).

curariform drugs

Diuretic-induced hypokalemia may enhance neuromuscular blocking effects of curariform drugs (such as tubocurarine) – the most serious effect would be respiratory depression which could proceed to apnea. Accordingly, it may be advisable to discontinue metolazone tablets, USP, three days before elective surgery.

salicylates & other non-steroidal anti-inflammatory drugs

May decrease the antihypertensive effects of metolazone tablets, USP.

sympathomimetics

Metolazone may decrease arterial responsiveness to norepinephrine, but this diminution is not sufficient to preclude effectiveness of the pressor agent for therapeutic use.

insulin & oral antidiabetic agents

See Glucose Tolerance under PRECAUTIONS, General.

methenamine

Efficacy may be decreased due to urinary alkalizing effect of metolazone.

anticoagulants

Metolazone, as well as other thiazide-like diuretics, may affect the hypoprothrombinemic response to anticoagulants; dosage adjustments may be necessary.

drug / laboratory test interactions

None reported.

carcinogenesis, mutagenesis, impairment of fertility

Mice and rats administered metolazone 5 days/week for up to 18 and 24 months, respectively, at daily doses of 2, 10, and 50 mg/kg, exhibited no evidence of a tumorigenic effect of the drug. The small number of animals examined histologically and poor survival in the mice limit the conclusions that can be reached from these studies.

Metolazone was not mutagenic in vitro in the Ames Test using Salmonella typhimurium strains TA-97, TA-98, TA-100, TA-102, and TA-1535.

Reproductive performance has been evaluated in mice and rats. There is no evidence that metolazone possesses the potential for altering reproductive capacity in mice. In a rat study, in which males were treated orally with metolazone at doses of 2, 10, and 50 mg/kg for 127 days prior to mating with untreated females, an increased number of resorption sites was observed in dams mated with males from the 50 mg/kg group. In addition, the birth weight of offspring was decreased and the pregnancy rate was reduced in dams mated with males from the 10 and 50 mg/kg groups.

teratogenic effects

pregnancy category b

Reproduction studies performed in mice, rabbits, and rats treated during the appropriate period of gestation at doses up to 50 mg/kg/day have revealed no evidence of harm to the fetus due to metolazone. There are, however, no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, metolazone tablets, USP, should be used during pregnancy only if clearly needed. Metolazone crosses the placental barrier and appears in cord blood.

non-teratogenic effects

The use of metolazone tablets, USP, in pregnant women requires that the anticipated benefit be weighed against possible hazards to the fetus. These hazards include fetal or neonatal jaundice, thrombocytopenia, and possibly other adverse reactions which have occurred in the adult. It is not known what effect the use of the drug during pregnancy has on the later growth, development, and functional maturation of the child. No such effects have been reported with metolazone.

Based on clinical studies in which women received metolazone in late pregnancy until the time of delivery, there is no evidence that the drug has any adverse effects on the normal course of labor or delivery.

Metolazone appears in breast milk. Because of the potential for serious adverse reactions in nursing infants from metolazone, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.

Safety and effectiveness in pediatric patients have not been established in controlled clinical trials. There is limited experience with the use of Upstate’s metolazone tablets, USP, in pediatric patients with congestive heart failure, hypertension, bronchopulmonary dysplasia, nephrotic syndrome and nephrogenic diabetes insipidus. Doses used generally ranged from 0.05 to 0.1 mg/kg administered once daily and usually resulted in a 1 to 2.8 kg weight loss and 150 to 300 cc increase in urine output. Not all patients responded and some gained weight. Those patients who did respond did so in the first few days of treatment. Prolonged use (beyond a few days) was generally associated with no further beneficial effect or a return to baseline status and is not recommended.

There is limited experience with the combination of metolazone tablets, USP, and furosemide in pediatric patients with furosemide-resistant edema. Some benefited while others did not or had an exaggerated response with hypovolemia, tachycardia, and orthostatic hypotension requiring fluid replacement. Severe hypokalemia was reported and there was a tendency for diuresis to persist for up to 24 hours after metolazone tablets, USP, were discontinued. Hyperbilirubinemia has been reported in 1 neonate. Close clinical and laboratory monitoring of all children treated with diuretics is indicated. See CONTRAINDICATIONS, WARNINGS, PRECAUTIONS.

Clinical studies of metolazone tablets, USP, did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.

This drug is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function.

Buy Zaroxolyn (metolazone) Online | Blink Health

Dizziness, lightheadedness, headache, blurred vision, loss of appetite, stomach upset, diarrhea, or constipation may occur as your body adjusts to the medication. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

This medication may lead to excessive loss of body water and minerals (including potassium). Tell your doctor right away if you have any of these unlikely but serious symptoms of dehydration or mineral loss: muscle cramps or weakness, confusion, severe dizziness, unusual dry mouth or thirst, nausea or vomiting, fast/irregular heartbeat, fainting, seizures.

Tell your doctor right away if any of these unlikely but serious side effects occur: numbness/tingling of the arms/legs, decreased sexual ability.

Tell your doctor right away if any of these highly unlikely but very serious side effects occur: persistent sore throat or fever, easy bleeding or bruising, stomach/abdominal pain, persistent nausea/vomiting, yellowing of eyes/skin, signs of kidney problems (such as change in the amount of urine).

Get medical help right away if you have any very serious side effects, including: decrease in vision, eye pain.

A serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction include: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US – Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada – Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

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Before you begin taking a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should take this medication.

Diabetes: If you have diabetes, your doctor should closely monitor your condition while you are taking metolazone, as it may affect blood sugar control (by increasing blood sugar levels).

Electrolytes: Metolazone may cause imbalances of electrolytes in the blood such as potassium, sodium, and magnesium. The signs of electrolyte imbalance include:

• drowsiness
• dry mouth
• lethargy
• low blood pressure
• muscle fatigue
• muscle pains or cramps
• racing heart rate
• reduced urine output
• restlessness
• stomach disturbances such as nausea and vomiting
• thirst
• weakness

If you have these symptoms, contact your doctor as soon as possible.

Gout: High blood uric acid levels may be brought on by metolazone. This may result in a gout attack for people with a history of gout. If you have a history of gout, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Kidney and liver function: If you have reduced kidney or liver function, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Low blood pressure: Some people taking metolazone experience sudden blood pressure drops when getting up from a sitting or lying position. These blood pressure drops could lead to dizziness, lightheadedness, and falls. If you experience this problem, try getting up more slowly. If it persists or if you faint, contact your doctor.

Systemic lupus erythematosus: This medication can worsen or activate the symptoms of lupus. If you experience swollen and painful joints, fever, fatigue, or rash on the nose and cheeks while taking this medication, contact your doctor.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: This medication passes into breast milk. If you are a breast-feeding mother and are taking metolazone, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children.

Metolazone (Zaroxolyn) Medicare Coverage

Prescription Drug Coverage

You may be able to find Medicare plan options in your area that cover Metolazone (generic Zaroxolyn). Learn more about Metolazone and find Medicare Advantage plans in your area that cover other prescription drugs.

Metolazone is a medication used to treat swelling (also called edema) due to fluid retention because of heart failure or kidney diseases. Metolazone uses sodium to help your body excrete extra fluid to reduce swelling.

Metolazone is taken once daily, typically in the morning. The brand name equivalent of Metolazone is called Zaroxolyn.

Common side effects of Metolazone include diarrhea, dizziness, sleepiness, headache, joint pain, upset stomach, bloating and stomach pain.

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Does Medicare cover Metolazone or Zaroxolyn?

Some Medicare Advantage plans and Medicare Part D plans in your area may cover Metolazone.

• Medicare Advantage plans that offer prescription drug coverage are called Medicare Advantage Prescription Drug Plans (MA-PD). Most Medicare Advantage beneficiaries (88 percent) are enrolled in MA-PDs.¹
• Medicare prescription drugs plans each have their own formulary, or drug list, that details what prescription drugs are covered by the plan and how they are covered.

Drug coverage may vary based on plan availability. You may be able to find Medicare Advantage plan options in your area that cover Metolazone.

Or call 1-800-557-6059 1-800-557-6059 TTY Users: 711 24/7 to speak with a licensed insurance agent.

You can also compare Part D prescription drug plans available where you live and enroll in a Medicare prescription drug plan online when you visit MyRxPlans.com.

Average costs for Metolazone with Medicare drug coverage

Your copay and deductible costs for any prescription drug can vary depending on what coverage stage you’re in and the Medicare drug plan you have.

Additional information

Metolazone will make you urinate more frequently to get rid of the extra fluid that is causing swelling. Metolazone should be taken a few hours before you go to bed, to avoid night time bathroom trips that disrupt sleep.

If you are taking Metolazone, you may be at a higher risk of electrolyte problems due to fluid loss. Signs of electrolyte problems can include confusion, muscle problems, abnormal heartbeat, extreme thirst, fatigue, dry mouth and upset stomach.

Kidney problems may also arise from an excess loss of fluid. Kidney problems can include the inability to pass urine, blood in the urine or a noticeable weight gain.

If you are diabetic, Metolazone may increase your blood sugar. Liver and pancreas problems have also rarely been reported by people taking Metolazone.

This article is for informational purposes only. It is not healthcare advice, treatment, or diagnosis. It is not an endorsement of or recommendation for this medication. Speak to your doctor or healthcare provider about your specific healthcare needs, including your prescription medications. Only take medication as directed by your doctor.

Coverage and costs of prescription medications will vary by Medicare plan. Not all plans are available in all areas.

Written by Hayden Gharibyar, Pharm.D.

Drug – Zytanix (5 mg) 5mg – 10 Tablets Tablet   (Metolazone) Price List or Cost of Medication

Drug information on Zytanix (5 mg) (Metolazone) from Zydus Cadila Healthcare Ltd.

(CND)

Drug Name : Metolazone

Metolazone(Zaroxolyn) generic Zytanix (5 mg) is a quinazoline diuretic, prescribed for high blood pressure. It helps the kidneys to ged rid of unwanted water and salt from the body into the urine.

More Info about Metolazone

Other Trade Names for Metolazone

India : 

More…

International : 

Zaroxolyn

Medindia currently has information on 3080 generic drugs and 110,061 brands that have their prices listed. New drugs with their prices are listed as and when they get approved by the drug controller. Please do write to us ([email protected]) if a drug is missing from our comprehensive drug price list.

Medical Condition(s) for which Zytanix (5 mg) may be prescribed

•   Heart :
Cold extremities, swelling, low blood pressure and palpitations.

•   Central Nervous System :

Anxiety, depression, dry mouth, impotence, nervousness, weakness and “weird” feeling.

•   Skin :

Itching, rash and skin dryness.

•   Eyes, Ears, Nose, Throat :

Cough, nose bleed, eye itching, sinus congestion, sore throat and ringing in the ears.

•   Gastrointestinal :

Abdominal discomfort (pain, bloating), bitter taste, constipation, diarrhea, nausea and vomiting.

•   Genitourinary :

Night-time urination.

•   Musculoskeletal :

Back pain.

PO- Adults- The recommended dose range is 2.5 – 10 mg/day.

It comes as a tablet to take by mouth, with food.

Contraindicated in patients with anuria (absence of urination), liver damage, and hypersensitivity.

• Caution should be exercised in patients with history of lupus, kidney or liver disease, low blood mineral levels, gout, any allergy, who are taking other medications, during pregnancy and breastfeeding.

•

It may cause drowsiness, dizziness, blurred vision or lightheadedness, do not drive a car or operate machinery while taking this medication.

•


Avoid alcohol consumption.

•


Avoid exposure to sunlight.

•


Monitor liver function, kidney function, and complete blood cell counts regularly while taking this medication.

Avoid excess dosage.

Store it at controlled room temperature (25°C).

ZAROXOLIN: instructions, reviews, analogs, price in pharmacies

ZAROXOLIN: instructions, reviews, analogs, price in pharmacies – Medcentre.com.ua

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How do you assess the effectiveness of ZAROXOLIN?

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Zaroxolin is a cardiological drug used for cardiovascular diseases.
Metolazone is a diuretic similar to thiazide diuretics.
The diuretic effect most often begins within an hour and reaches its peak after about two hours. It lasts about 24 hours.

Indications for use

Preparation Zaroxolin is used in the treatment of hypertension and is used as a diuretic.

Directions for use

For hypertension, the initial dose of the drug Zaroxolin is 5 mg per day, two weeks later you can take the same dose every other day.
In renal failure, 5-20 mg is required in divided doses.
For heart failure – 5-10 mg.

Side effects

When using the drug Zaroxolin , the following side effects may occur: heart palpitations, dizziness, headache, drowsiness, anxiety, insomnia, gastrointestinal disorders, skin rash.

Contraindications

Contraindications to the use of the drug Zaroxolin are:
– hypersensitivity or allergic reaction to the active or auxiliary substance of the drug
– hepatic or renal failure.

Pregnancy

Preparation Zaroxolin is not recommended for use during pregnancy and lactation.

Overdose

In case of an overdose of the drug Zaroxolin , dehydration may occur.

Storage conditions

Store in a place protected from moisture and sun at room temperature.
Expiration date: 4 years.

Release form

Zaroxolin – tablets.
Packing: 5 blisters in a cardboard box, 10 tablets each.

Composition

1 tablet of Zaroxolin contains: metolazone.
Excipients: microcrystalline cellulose, magnesium stearate.

Basic parameters

ZAROXOLIN reviews

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SELF-TREATMENT CAN HARM YOUR HEALTH

Zaroxolin: instructions, reviews, analogs, price in pharmacies

Zaroxolin is a cardiological drug that is used in cardiovascular diseases.
Metolazone is a diuretic similar to thiazide diuretics.
The diuretic effect most often begins within an hour and reaches its peak after about two hours. It lasts about 24 hours.

Indications for use:
Preparation Zaroxolin is used in the treatment of hypertension and is used as a diuretic.

Method of application:
In case of hypertension, the initial dose of the drug Zaroxolin is 5 mg per day, two weeks later you can take the same dose every other day.
In renal failure, 5-20 mg is required in divided doses.
For heart failure – 5-10 mg.

Side effects:
When using the drug Zaroxolin , the following side effects are possible: heart palpitations, dizziness, headache, drowsiness, anxiety, insomnia, gastrointestinal disorders, skin rash.

Contraindications:
Contraindications to the use of the drug Zaroxolin are:
– hypersensitivity or allergic reaction to the active or auxiliary substance of the drug
– hepatic or renal failure.

Pregnancy:
Preparation Zaroxolin is not recommended for use during pregnancy and lactation.

Overdose:
In case of an overdose of Zaroxolin , dehydration may occur.

Storage conditions:
Store protected from moisture and sun at room temperature.
Expiration date: 4 years.

Release form:
Zaroxolin – tablets.
Packing: 5 blisters in a cardboard box, 10 tablets each.

Composition:
1 tablet of Zaroxolin contains: metolazone.
Excipients: microcrystalline cellulose, magnesium stearate.

Clinical Study Heart Failure: tolvaptan, Chlorothiazide, Metolazone – Clinical Trials Registry

Background:

guidelines are weak due to lack of evidence.The efficacy, cost and side effects of the currently recommended treatments and testing of a new combination of diuretics, researchers will fill the gaps in data that exist regarding this clinical problem.

Current guidelines for heart failure recommend the addition of thiazide diuretics, including oral metolazone or intravenous chlorothiazide, to short-circuit diuretic therapy as a strategy to overcome loop diuretic resistance.at equal doses, the two treatments differ 250-fold. To date, no prospective study has compared the efficacy of the two therapies used.

Tolvaptan, an oral vasopressin 2 receptor antagonist, can restore diuretic effects when used in combination with loop diuretics. Although the safety of this combination has been established in the EVEREST trials, tolvaptan has been formally studied to a limited extent. as a combination therapy to restore resistance to loop diuretics.Hypokalemia is a common adverse event. the effect of a combination of thiazide and loop diuretics, increasing the risk of atrial and ventricular arrhythmias in populations already at high risk. a combination of tolvaptan and loop diuretics has been reported, probably due to the action of tolvaptan. a distinctive mechanism of action This potential benefit may give tolvaptan a unique advantage for combination diuretic therapy in settings where electrolyte monitoring cannot be routinely performed or in patients with frequent arrhythmias.

Methods:

All patients will provide informed consent prior to enrollment in the study. randomized 1: 1: 1 using the electronic randomization tool built into REDCAP. patients will begin with a fluid restriction of 2 L / day and a sodium restriction of 2 g / day. Decisions regarding the initiation, titration or termination of standard heart failure drugs (angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, aldosterone antagonists, beta-blockers, digoxin, hydralazine, nitrates) are left to the discretion of the treating physician.Patients will be randomized to intravenous chlorothiazide 500 mg intravenous Q12H + oral placebo capsule Q12H or placebo intravenous infusion Q12H + capsule containing metolazone oral 5 mg oral Q12H or tolvaptan 30 mg single dose oral daily versus evening placebo capsule 100 times more potent than chlorothiazide) Replacement of all electrolytes, dose titration of loop diuretics and concomitant therapies to increase urine output, if necessary, will be used by the physician. your discretion.

To prevent heterogeneity in diuretic treatment, a staged treatment algorithm similar to the CARRESS-HF trial will be used for loop diuretics, both initial dose and subsequent dose changes, and for concomitant inotropes and vasodilators. A minimum equivalent dose of furosemide 580 mg / 24 h (100 mg IV bolus + 20 mg / h infusion) must be ordered at enrollment.

Results The primary outcome would be a change in weight standing on a 48 hour scale (kg) with Metolazone, IV Chlorothiazide and Tolvaptan included in the groups using the Metolazone group as the comparison group for all other groups.

Secondary outcomes when using metolazone as a comparison group for each of them will be:

– 48-hour net urine output (ml)

– mean change in serum creatinine, blood urea nitrogen and eGFR after 24 hours 48 hours, and at discharge from hospital

– mean change in diuretic efficacy at 24 and 48 hours compared to baseline at registration

– mean change in serum potassium at 24 and 48 hours compared to baseline at inclusion

– mean change in serum sodium at 24 hours , 48 hours and at discharge from baseline registration

– cumulative dose of potassium (meq) and magnesium (g) supplements administered at 24 years and 48 hours

– frequency of severe hypokalemia

– need for escalation of therapeutic loop diuretic therapy under study control after 24 and 48 hours

– adding vasoactive or other tropic drugs after 24 and 48 hours

– Treatment failure (defined below)

– Patient score on a visual analogue scale of congestion at baseline, after 24 and 48 hours

– new cardiac arrhythmias (atrial and ventricular) during the study period

– taking inotropic therapy, dopamine or nitroglycerin; requirement for ultrafiltration or hemodialysis during the main hospitalization

– hospital mortality

– pharmacoeconomic analysis of direct costs in each group, including costs: drug research, additional costs for laboratory analysis of the protocol without tests related to electrolyte monitoring, treatment of side effects associated with study drugs (arrhythmias, hypotension, electrolyte replenishment), increasing doses of loop diuretics, adding additional treatments for suboptimal diuresis (inotropic therapy, vasodilators), and re-starting renal replacement therapy (hemodialysis or ultrafiltration).

Study definitions

– Diuresis: total urine volume (ml) from study enrollment up to 48 hours.

– Hypokalemia: Serum potassium level & lt; 3.5 mEq / L

– Severe hypokalemia: Serum potassium level & lt; 3.0 mEq / L.

– Hyponatremia: Serum sodium level & lt; 135 mEq / L

– Severe hyponatremia: Serum sodium level & lt; 130 mEq / L and a decrease of 5 mEq / L or more from Serum Sodium Kit

– Over-correction of serum sodium: increase in serum sodium from baseline by & gt; 12 mEq / L over 24 years.hours, increase & gt; 8 mEq / L in 12 hours or intravenous fluids due to symptoms of overcorrection of serum sodium levels regardless of numerical increase

– Hypomagnesemia: Serum magnesium <2 mEq / L

– Diuretic efficacy = 24 hour urine output / 24 hour Lasix equivalent in milligrams

– Weight: constant weight on the same scale as the original weight.

– New atrial arrhythmia: “new” diagnosis of atrial arrhythmia (includes atrial arrhythmia). atrial fibrillation, atrial flutter, ectopic atrial tachycardia) lasting more than 30 seconds OR any atrial arrhythmia causing hemodynamic instability (SBP <60 and requiring intervention)

– New ventricular arrhythmias: ventricular tachycardia lasting longer than 30 seconds hemodynamic instability with SBP & lt; 60 mm Hg. Art. requiring intervention or & gt; 1 intracardiac defibrillation or external cardiac defibrillation shock or ventricular fibrillation requiring defibrillation

– Hypotension: SBP & lt; 85 for 2 repeated measurements within 30 minutes or at least 30 minutes duration or symptomatic hypotension requiring clinical intervention (defined as vasopressor support, IV fluid boluses or inotropes)

– Treatment failure: patients requiring an additional diuretic not included in the study (spironolactone doses> 75 mg / day, eplerenone> 75 mg / day, thiazides not included in the study (at the dose of metolazone 2.5 mg or more) or loop diuretics, or systemic acetazolamide (for diuretics, indications), triamterene, or amiloride therapy) at any time within 48 hours. period of randomization. These patients will be considered untreated by the goal of the analysis of the primary endpoint and all secondary endpoints.

– Patients whose cardiologist adds inotropic or vasodilator drugs will not be considered a treatment failure. Patients who require an increase in loop diuretic regimen will also not be considered a treatment failure.

– The cost of drugs will be determined as the average wholesale price of the Redbook at the time of the trial to reduce interdepartmental price differences and increase the external validity of the analysis.

Statistical Analysis Researchers have partnered with the Department of Biostatistics Vanderbilt University Medical Center uses the best statistical techniques that allow research to be realistic and achievable. Calculation of power is difficult due to the lack of prospective studies comparing combination diuretic therapy and the numerous shortcomings of the methods of these previous studies. The researchers will use weight change as the primary outcome because weight change was used as the primary efficacy outcome in the landmark trials of heart failure diuretics (CARRESS-HF) and have a lower standard deviation than net diuresis. In previous studies, the standard deviation of weight change between groups. varied with an approximate value of 1.6 kg. If the minimum clinically significant difference in the experimental control agent is 1.5 kg, the researchers will be able to reject the null hypothesis that the population averages of the experimental and control groups are equal with a power of 82.3%. The probability of type I error associated with this test of this null hypothesis is 0.05. The researchers will use Wilcoxon’s univariate hypothesis.analysis of the sum of the ranks for the independent continuous variable of the primary outcome using metolazone as a comparison group for intravenous chlorothiazide and oral tolvaptan. the researchers will also perform multivariate linear model corrected analyzes of the main outcomes corrected for baseline weight and loop diuretic regimen. …

Relative contraindications to the use of CCBs in hypertension

– Tachyarrhythmias (long-acting and long-acting dihydropyridines).

– Heart failure (long-acting and long-acting dihydropyridines).

CCLs have some peculiarities of influence on various “endpoints”. So, against the background of therapy with drugs of this group, the risk of developing heart failure and myocardial infarction is slightly higher than against the background of therapy with other antihypertensive drugs. At the same time, CCBs reduce the risk of cerebral stroke to a slightly greater extent than other antihypertensive drugs.

Additional indications for the appointment of dihydropyridine CCBs are: an elderly patient, isolated systolic arterial hypertension, the presence of concomitant exertional angina, peripheral arterial disease, signs of atherosclerotic changes in the carotid arteries, pregnancy.For nondihydropyridine calcium channel blockers, additional indications for the appointment are concomitant exertional angina, signs of atherosclerotic changes in the carotid arteries, supraventricular rhythm disturbances.

Some information on the use of calcium channel blockers in hypertension are given in table. 2.8.

Short-acting nifedipine (in contrast to its long-acting forms) with prolonged use worsens the prognosis of patients with hypertension, coronary heart disease, therefore it is not used for systematic treatment of hypertension.

Side effects CCL

Blockade of calcium channels in the heart can lead to bradycardia, atrioventricular block, cardiodepression. These side effects are common with phenylalkylamines.

The result of blockade of calcium channels of peripheral vessels is orthostatic hypotension, reflex tachycardia. In addition, patients may experience: facial redness, swelling of the ankles of non-cardiac origin caused by vasodilation, gingivitis, and constipation.

Diuretics

The widespread use of diuretic drugs for antihypertensive therapy is due to the fact that their treatment is cost-effective and does not cause an excessive decrease in blood pressure, and therefore there is no need for frequent medical supervision; in addition, the drugs do not induce a rebound phenomenon. Diuretics are the drugs of choice in the treatment of hypertension in the elderly, including those with heart failure.

Classification of diuretics

1.Acting on the thick ascending part of the loop of Henle (loop diuretics):

– Furosemide (Lasix).

– Bumetanide (Bufenox).

– Pyrethanides (Arelix).

– Ethacrynic acid (Uregit).

– Torasemid (Diuver).

2. Acting on the initial part of the distal tubule:

2.1. Thiazide diuretics (benzothiadiazine derivatives):

– Dichlothiazide (Hypothiazide).

– Metolazone (Zaroxolin).

– Cyclomethiazide (Cyclopentiazide).

– Polythiazide (Renese).

2.2. Non-thiazide (thiazide-like) diuretics:

– Clopamide (Brinaldix).

– Chlorthalidone (Oxodolin).

– Indapamide (Arifon).

– Xipamide (Aquaphor).

3. Acting on the terminal part of the distal tubule and collecting ducts (potassium-sparing diuretics):

3. 1. Competitive aldosterone antagonists:

– Spironolactone (Veroshpiron).

– Eplerenone (Inspra).

Table 2.8. Recommended doses, frequency of administration and individual pharmacokinetic parameters of calcium channel blockers used for the treatment of arterial hypertension

End of table 2.8

Note: * – for forms of prolonged action.

3.2. Sodium channel blockers:

– Triamteren (Daitek).

– Amiloride (Modamid).

4. Acting on the proximal tubule (carbonic anhydrase inhibitors):

– Acetazolamide (Diacarb).

5. Combined preparations:

– Triampur (triamterene + dichlothiazide).

– Moduretic (amiloride + dichlothiazide).

– Furesis (furosemide + triamterene).

– Spiro-D (furosemide + spironolactone).

Thiazide and thiazide-like diuretics are most commonly used to treat hypertension. In the mechanism of their hypotensive action, two components can be conventionally distinguished. The first is associated with the diuretic effect itself and is realized at the cellular level by suppressing the electrically neutral transport of Na ⁺ and Cl ^– through the luminal membrane of the distal convoluted tubules, which leads to an increase in sodium excretion and, consequently, water.This is accompanied by a decrease in the BCC and, accordingly, a decrease in the return of blood to the heart and cardiac output. This mechanism underlies the positive effect of thiazide diuretics in the first weeks of hypertension treatment and is dose-dependent (manifests itself in diuretic doses).

The second component manifests itself even when administered in non-diuretic doses and is due to a decrease in OPSS due to:

– increased excretion of Na + and water from the vascular wall, leading to a decrease in its thickness and response to pressor effects;

– decrease in the sensitivity of adrenergic receptors to catecholamines;

– stimulation of the synthesis of vasodilating prostaglandins;

– metabolic disorders of Ca ²⁺ and Na ⁺ in vascular smooth muscle cells.

Comparative studies have shown that there is no significant difference in the antihypertensive activity of low (less than 25 mg hydrochlorothiazide per day or equivalent doses of other drugs) and high doses (more than 25 mg) thiazide diuretics. At the same time, low doses of diuretics are much better tolerated by patients and are not accompanied by significant electrolyte and metabolic disturbances.

Unlike β-blockers, diuretics are equally effective in preventing cardiovascular complications in patients with hypertension, both middle-aged and elderly, and can improve the long-term prognosis in these patients with arterial hypertension.Diuretics are more effective than β-blockers in preventing the development of coronary artery disease and death, which makes them one of the first-line drugs in the initial therapy of hypertension.

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Dimekolin – complete information on the drug and instructions. Indications for use, analogues of the drug Dimekolin, method of administration, side effects, contraindications, pregnancy, overdose, interaction, mechanism of action, price in pharmacies, answers to questions, consultations.DIMEKOLIN (pharmacological analogs: dimecolin iodide) – is similar in action to benzohexonium.

Dimekolin has the same indications for use, side effects and contraindications. Caution is required when combined with nitroglycerin, the effect of which is potentiated by dimecolin.

Dimecolin release form: tablets of 0, g. List B. An example of a dimecolin recipe in Latin: Rp .: Tab. Instructions, characteristics, description, application, reviews and price Ivermicol 1%, 1 ml. (water base).Instructions for use Zaroxolin tab. (Metolazone) 10mg No. The instructions provide a description, composition, method of administration, dosage. Price, analogues and reviews for the drug. The instruction was developed by NIID. Authors: Tsvirova I.M., Panteleeva L.G. , Abramova I.M., Belova A.S., Dyakov V.V., Fedorova L.S., Pankratova G.P., Rysina T.Z., Zakova I.M.

1. GENERAL INFORMATION. Means “Alaminol” is a transparent liquid concentrate from blue to green-blue color, has a faint odor of perfume, mixes well with water.

Instruction. Release form. Analogs Reviews 2. Pharmacies. Instruction. Instructions for use of Mexidol sol. for i / v and i / m int. 50 mg / ml amp. 2 ml 20 Pcs. Short description. Pharmachologic effect. Indications. Method of administration and dosage. Polysorb instructions for use to cleanse the body. Polysorb – instruction. Method of administration and dosage. Indications for use. Pharmachologic effect. Side effects and contraindications. Polysorb – dosage and method of administration.

First, Polysorb is always taken in the form of an aqueous suspension, that is, the powder is mixed with 1/4 – 1/2 cup of water, and is never taken dry internally.Instructions for use for the drug Dimekolin. As well as indications for use and side effects.

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90,000 Hypertension: Diuretic Treatment – Medical Portal EUROLAB

Diuretics, often called diuretics, help the body get rid of unnecessary water and salt when urinating.Getting rid of excess salt and fluid lowers blood pressure and improves heart performance. Diuretics can be used to treat a number of heart conditions, including high blood pressure, liver and kidney disease, and glaucoma. Examples of diuretics include:

• Ezidrix (hydrochlorothiazide)

• Lasix (furosemide)

• Bumex (bumetanide)

• Demadex (torasemide)

• Zaroxolin (Metolazone)

• Aldactone (spironolactone)

Diuretics are divided into thiazide-like (Zaroxolin and Ezidrix), loop (Lasix, Bumex) or potassium-sparing (Aldactone). Thiazide-like diuretics are most effective in lowering blood pressure, causing the excretion of salts from the body, and are suitable for long-term use. Loop diuretics are more potent and often used for symptoms of congestive heart failure, and are especially effective in emergencies. Potassium-sparing diuretics help the body store potassium and are often used in the treatment of patients with congestive heart failure in combination with other types of diuretics.

Side effects

• Arrhythmia (irregular heart rhythm)

• Frequent urination. May continue for several hours after taking the drug.

• Electrolyte imbalance . It is important to have a blood test for electrolytes before and during the use of these drugs.

• Great tiredness or weakness. These effects should decrease as the body adjusts to the drug. See your doctor if symptoms persist.

• Muscle cramps and muscle weakness . Make sure you are taking potassium supplements correctly if prescribed by your doctor. See your doctor if symptoms persist.

• Dizziness. Try to get up more slowly when you get out of a chair or bed.

• Blurred vision, blurred consciousness, headache, increased sweating and restlessness. If these effects bother you and persist, seek medical attention.

• Dehydration. Symptoms include dizziness, intense thirst, excessive dry mouth, decreased urination, dark urine, and constipation. If you have these symptoms, do not feel that you need to take more fluids, see your doctor.

• Fever, sore throat, cough, ringing in the ears, unreasonable bleeding or bruising, rapid and excessive weight loss. See a doctor immediately.

• Skin rash. Stop taking medication and see a doctor immediately.

• Loss of appetite, nausea, vomiting, or muscle cramps. Make sure you are taking potassium supplements correctly if prescribed by your doctor.

• Rarely, potassium-sparing diuretics such as Aldactone can cause chest enlargement, rough voice, increased hair growth, and irregular menstrual cycles in men and women.

See your doctor if you have other symptoms that bother you.

Medical advice on the use of drugs

• Before your doctor prescribes a diuretic, tell him if you are taking any other medications or herbal medicines.Also tell your doctor if you have any other medical conditions.

• Follow your doctor’s instructions regarding the schedule for using the drug. If you are taking one dose a day, it is best to take it in the morning rather than at night so that you do not have to interrupt your sleep with frequent trips to the toilet. (This is especially important for patients with congestive heart failure or cirrhosis with portal hypertension.)

• While taking your medications, regularly measure your blood pressure and check your kidneys as recommended by your doctor.

• See your doctor regularly and get all the tests you need so the doctor can monitor your response to the drug.

Interaction with food and other drugs

Diuretics are often prescribed as a single tablet with other drugs for high blood pressure and heart disease. This can increase the side effect of these drugs or cause electrolyte imbalances such as potassium.

If you have any side effects after combining several drugs, see your doctor. You may need to change the timing of each drug.

Follow your healthcare provider’s dietary recommendations. These could be the following recommendations:

• Eat foods that are low in salt.

• Take potassium supplements or foods rich in potassium (such as bananas or orange juice).Note that some types of diuretics remove potassium from the body.

• If you are taking potassium-sparing diuretics such as aldactone, your doctor may advise you to avoid potassium-rich foods, salt substitutes, low-salt milk, and other sources of potassium.

Alcohol and sleeping pills can increase the side effects of these drugs and should be avoided.

Can pregnant women take diuretics?

Diuretics are not recommended for pregnant women.The effect of the drug on newborns is unknown.

Can women who are breastfeeding take diuretics?

No. Many diuretics pass into milk and can cause dehydration in babies.

Can children take diuretics?

Children can safely take diuretics. The side effects are the same as in adults. Children should be given a lower dose of drugs. Potassium-sparing diuretics such as Aldactone can cause calcium deficiency.

Can older people take diuretics?

As with other drugs, diuretics should be used with caution in the elderly. These drugs can be very helpful for the elderly, but the doctor should monitor their use carefully. Older adults are more likely to experience side effects such as loss of consciousness and dizziness due to dehydration.

90,000 LOSE HYPERTENSION WITH DIURETICS: SIDE EFFECTS AND OVERVIEW – CARDIOVASCULAR

Diuretics, also known as water pills, are a class of medicines that remove excess salt and water from the body.They are often used to treat hypertension or high blood pressure. High blood pressure can be a contributing factor to the development of various forms of heart disease.

Diuretics have proven effective in preventing heart attack and stroke in many people when chosen as the treatment for hypertension. Certain foods and herbs are also diuretic, helping you urinate more often to flush excess fluids and sodium.

Pharmaceutical diuretics

Prescription diuretics are divided into three main types.

Thiazide

Thiazide diuretics help treat hypertension by causing blood vessels to dilate and drain excess fluid from the body. Examples of thiazides include metolazone (Zaroxolin), indapamide (Lozol), and hydrochlorothiazide (Microside).

Loop diuretics

Loop diuretics remove excess fluid by causing the kidneys to produce more urine. These include furosemide (Lasix), ethacrynic acid (Edecrin), and torsemide (Demadex).

Potassium-sparing

Potassium-sparing diuretics encourage the body to eliminate fluids and sodium.However, they do this without causing loss of potassium, which is a vital nutrient. Examples of potassium-sparing diuretics include triamterene (Dyrenium), eplerenone (Inspra), and spironolactone (Aldactone).

Each of the three types of diuretics increases the amount of sodium you pass when you urinate, but they affect different areas of your kidneys. The kidneys are filters through which toxins and excess fluid are removed from the body. When you take a diuretic, it signals your kidneys to get rid of sodium.Water binds to sodium and is then removed during urination, causing blood volume to decrease. The decrease in blood volume reduces the rate at which blood flows through the blood vessels, helping to lower blood pressure.

Thiazide and loop diuretics can also cause loss of potassium in addition to water and sodium. Potassium is an essential mineral that maintains healthy fluid levels and regulates heart and muscle function. Your doctor may advise you to take potassium supplements or eat nutrient-rich foods to combat low potassium levels.Potassium-rich foods include:

• bananas
• avocados
• raisins
• beans
• dark green leafy vegetables such as cabbage and spinach
• squash
• mushrooms
• potatoes

fish

• 903 potatoes

Potassium-sparing diuretics do not pose as much of a threat to potassium levels. However, they are not as effective in treating hypertension as other types of diuretic drugs, so they are often prescribed in conjunction with other medications.

Thiazide diuretics are the main treatment for people with heart disease associated with hypertension. However, your doctor will tailor a medication regimen based on your specific health concerns. Your specific medicine may contain more than one type of diuretic per tablet or dose.

Risks and Side Effects

Diuretics are generally safe for most people when taken as directed.

The most common side effect of diuretics is urinary frequency. Potassium, glucose, and cholesterol levels can fluctuate depending on the type of diuretic you are taking. Your doctor may do blood tests to measure your level during treatment.

Other side effects may include:

• headaches
• dizziness or lightheadedness
• difficulty sleeping
• muscle weakness or spasms
• increased thirst
• irregular menstruation
• with erectile dysfunction

or conditions causing swelling and pain in the joints of the foot

Side effects may decrease over time.Be sure to tell your doctor if you experience any uncomfortable or long-term side effects when taking a diuretic. Your doctor may adjust your dosage or switch you to a different type of diuretic.

Natural Diuretics

Certain foods and herbal supplements may have a diuretic effect on the body by increasing urine output. Examples of natural diuretics include:

Ginger Root

When steeped in tea or used as a spice in cooking, it can stimulate the body to remove excess salt and water.Ginger root can also relieve indigestion.

Celery

Due to its high water content, celery can help increase urine production and aid in the elimination of excess sodium and fluid.

Dandelion Root

This herbal root promotes urine excretion by helping the kidneys eliminate excess sodium and other toxins.

Natural diuretics may be helpful for high blood pressure, but should be used with caution.Taking a natural diuretic, even unintentionally as part of a normal diet, along with pharmaceuticals can lead to dehydration and other potentially harmful drug interactions. Talk with your doctor to find out which natural diuretics are suitable for treating your condition.

Question:

Should some people avoid diuretics for hypertension?

A:

Pregnant women should avoid taking natural or prescription diuretics, but a prescription diuretic may be needed to treat serious medical conditions as identified by a doctor.Hydrochlorothiazide (microside) has been used in infants and children and is generally considered safe for all ages as long as they are not allergic to hydrochlorothiazide.

Alan Carter, PharmD

Answers reflect the views of our medical experts. All content is for informational purposes only and should not be construed as medical advice.

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